Lets Create A Ptsd Diagnosis

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anthony

Founder
This is a sufferers view for what the PTSD diagnosis should be. I would suggest it is done in such a way that it covers both trauma and complex trauma in a single diagnosis.

See the following reply for further information -- this first post will contain the completed diagnostic solution.
---------------------- Start Diagnosis --------------------------------

A. An event in which one of the following were present:
(1) Directly experiencing or witnessing actual or immediate threat of death, catastrophic injury, or sexual violence.
(2) Direct and frequent exposure, over a prolonged period, to recordings of actual death, catastrophic injury or sexual violence against people, where that exposure is non voluntary or for work purposes.

B. Presence of two (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
  1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
  2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note:In children, there may be frightening dreams without recognizable content.
  3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
  4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
  5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidence by one or both of the following:
  1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
  2. Avoidance of or efforts to avoid external stimuli such as places, conversations, activities, objects, and situations that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by three (or more) of the following:
  1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
  2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “no one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
  3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
  4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
  5. Markedly diminished interest or participation in significant activities.
  6. Feelings of detachment or estrangement from others.
  7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by three (or more) of the following:
  1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
  2. Reckless or self-destructive behavior.
  3. Hypervigilance, expressed as heightened sensitivity to potential threats (e.g., fear of motor vehicles following an accident), whether related or unrelated to the traumatic event (e.g., fear of sudden shock causing a heart attack).
  4. Exaggerated startle response.
  5. Problems with concentration, such as difficulty remembering daily events or attending to focused tasks (e.g., reading, conversing)
  6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
  7. Somatization relating to the traumatic event(s), marked by significant distress or disruption to daily life.
F. Duration of disturbance (Criteria B, C, D, and E) is more than 1 month.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Specifiy whether:

With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
  1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one's mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
  2. Derealization: Persistent or recurent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
  3. Regulation: Persistent inability to regulate emotion leading to suicidal tendencies, self-mutilation and self-destructive behaviors.
Note: To use this subtype, the dissociative / regulation symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Specify if:

With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

---------------------- End Diagnosis --------------------------------
 
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anthony

Founder
Firstly, I would suggest you manually watch this thread if you want to stay involved, that way you get alerts to stay abreast of it without having necessarily commenting to it until you're ready.

I'm writing an article about PTSD's future, and it encompasses some primary concerns associated with PTSD to date. The problem is that it's easy to talk about, or find, problems. So I want to add a solution to the article, and maybe that might be the sufferers way to get our views and experiences to these experts who maintain doctrine.

In many of the journal and study pieces I've read, lots of problems, few sound, viable solutions.

Big fan of many heads are best. Please DO NOT derail this thread with noise and nonsense. The more focused, on point and accurate your input, the better. Diagnoses are not long winded documents, it is more the aspects of the diagnosis that we as sufferers should be more concerned, for both getting the diagnosis and the criterion as accurate and befitting as possible.

In other words, make things broad and you create loopholes (interpretations from word meaning) which professionals exploit. Make criterion too easy, then the diagnosis looses purpose for those who meet catastrophic trauma.

This will be a significant "food for thought" discussion. We need to take one piece at a time, getting it the best we can, then moving on. Come back to any burning issues once constructed, after being prior settled.
 
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anthony

Founder
Diagnostic History

I have only used the revised versions, for ease, which whilst fix issues of prior versions, also create their own issues. This is to help us only.
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DSM III-R

DIAGNOSTIC CRITERIA FOR 309.89 POST-TRAUMATIC STRESS DISORDER.

A. The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone, e. g., serious threat to one's life or physical integrity; serious threat or harm to one's children, spouse, or other close relatives and friends; sudden destruction of one's home or community; or seeing another person who has been or is being, seriously injured or killed as the result of an accident or physical violence.

B. The traumatic event is persistently reexperienced in at least one of the following ways:

(1) recurrent and intrusive disturbing recollections of the event (in young children, repetitive play in which themes or aspects of the trauma are expressed).
(2) recurrent distressing dreams of the event
(3) sudden acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative [flashback] episodes, even those that occur upon awakening or when intoxicated)
(4) intense psychological distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the trauma

C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

(1) efforts to avoid thoughts or feelings associated with the trauma
(2) efforts to avoid activities or situations that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma (psychogenic amnesia)
(4) markedly diminished interest in significant activities (in young children loss of recently acquired developmental skills such as toilet training or language skills.
(5) feeling of detachment or estrangement from others
(6) restricted feeling of affect, e.g. unable to have loving feelings
(7) sense of a foreshortened future, e. g. does not expect to have a career, marriage, or children, or a long life

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:

(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response
(6) physiologic reactivity upon exposure to events that symbolize or resemble an aspect of the traumatic event (e.g., a woman who was raped in an elevator breaks out in a sweat when entering any elevator)

E. Duration of the disturbance (symptoms in B, C, and D of at least one month.

Specify delayed onset if the onset of symptoms was at least six months after the trauma.

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DSM IV-TR

A. The person has been exposed to a traumatic event in which both of the following were present:
  • (1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
  • (2) The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
  1. The traumatic event is persistently reexperienced in one (or more) of the following ways:
    • (3) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
    • (4) Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
    • (5) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience; illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
    • (6) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
    • (7) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
  2. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
    • (8) Efforts to avoid thoughts, feelings, or conversations associated with the trauma
    • (9) Efforts to avoid activities, places, or people that arouse recollections of the trauma
    • (10) Inability to recall an important aspect of the trauma
    • (11) Markedly diminished interest or participation in significant activities
    • (12) Feeling of detachment or estrangement from others
    • (13) Restricted range of affect (e.g., unable to have loving feelings)
    • (14) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal lifespan)
  3. D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
    • (1) Difficulty falling or staying asleep
    • (2) Irritability or outbursts of anger
    • (3) Difficulty concentrating
    • (4) Hypervigilance
    • (5) Exaggerated startle response
  4. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
  5. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:

Acute: if duration of symptoms is less than 3 months

Chronic: if duration of symptoms is 3 months or more

Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the stressor.

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DSM V (Current Version)

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
  1. Directly experiencing the traumatic event(s),
  2. Witnessing, in person, the event(s) as it occurred to others,
  3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent and accidental.
  4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure to electronic media, television, movies, or pictures, unless the exposure is work related.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
  1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
  2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note:In children, there may be frightening dreams without recognizable content.
  3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
  4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
  5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidence by one or both of the following:
  1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
  2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
  1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
  2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “no one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
  3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
  4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
  5. Markedly diminished interest or participation in significant activities.
  6. Feelings of detachment or estrangement from others.
  7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
  1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
  2. Reckless or self-destructive behavior.
  3. Hypervigilance.
  4. Exaggerated startle response.
  5. Problems with concentration.
  6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F. Duration of disturbance (Criteria B, C, D, and E) is more than 1 month.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Specifiy whether:

With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
  1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one's mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
  2. Derealization: Persistent or recurent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Specify if:

With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

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Complex Trauma Diagnostic Aspects

The original author claims seven characteristic differences, which are:
  1. Alterations in the regulation of affective impulses, including difficulty with modulation of anger and self-destructiveness,
  2. Alterations in attention and consciousness leading to amnesias and dissociative episodes and depersonalization,
  3. Alterations in self-perception, such as chronic sense of guilt and responsibility, and ongoing feelings of intense shame,
  4. Alterations in perception of the perpetrator, including incorporation of his or her belief system,
  5. Alterations in relationship to others, such as not being able to trust and not being able to feel intimate with others,
  6. Somatization of medical problems, and
  7. Alterations in systems of meaning, including feelings of hopelessness about finding anyone to understand his or her pain.
More recent claims and modifications to the above, explained in different wording:

  1. Attachment – “problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to other’s emotional states, and lack of empathy”
  2. Biology – “sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems”
  3. Affect or emotional regulation – “poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes”
  4. Dissociation – “amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events”
  5. Behavioral control – “problems with impulse control, aggression, pathological self-soothing, and sleep problems”
  6. Cognition – “difficulty regulating attention, problems with a variety of “executive functions” such as planning, judgement, initiation, use of materials, and self- monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with “cause-effect” thinking, and language developmental problems such as a gap between receptive and expressive communication abilities.”
  7. Self-concept -“fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self”.
DESNOS Proposed Criterion
  1. Alteration in Regulation of Affect and Impulses (A and 1 of B–F required):
    1. Affect Regulation (2)

    2. Modulation of Anger (2)

    3. Self-Destructive

    4. Suicidal Preoccupation

    5. Difficulty Modulating Sexual Involvement

    6. Excessive Risk-taking
  2. Alterations in Attention or Consciousness (A or B required):

    A. Amnesia
B. Transient Dissociative Episodes and

Depersonalization
  1. Alterations in Self-Perception

    (Two of A–F required):
    1. Ineffectiveness

    2. Permanent Damage

    3. Guilt and Responsibility

    4. Shame

    5. Nobody Can Understand

    6. Minimizing
  2. Alterations in Relations With Others

    (One of A–C required):
    1. Inability to Trust

    2. Revictimization

    3. Victimizing Others
  3. Somatization
    (Two of A–E required):
    1. Digestive System

    2. Chronic Pain

    3. Cardiopulmonary Symptoms

    4. Conversion Symptoms

    5. Sexual Symptoms
  4. Alterations in Systems of Meaning (A or B required):

    A. Despair and Hopelessness
B. Loss of Previously Sustaining Beliefs

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ICD 10 PTSD

F43.1 Post-traumatic stress disorder
Diagnostic Criteria

A. Exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.

B. Persistent remembering or "reliving" the stressor by intrusive flash backs, vivid memories, recurring dreams, or by experiencing distress when exposed to circumstances resembling or associated with the stressor.

C. Actual or preferred avoidance of circumstances resembling or associated with the stressor (not present before exposure to the stressor).

D. Either (1) or (2):

(1) Inability to recall, either partially or completely, some important aspects of the period of exposure to the stressor

(2) Persistent symptoms of increased psychological sensitivity and arousal (not present before exposure to the stressor) shown by any two of the following:

a) difficulty in falling or staying asleep;

b) irritability or outbursts of anger;

c) difficulty in concentrating;

d) hyper-vigilance;

e) exaggerated startle response

E. Criteria B, C (For some purposes, onset delayed more than six months may be included but this should be clearly specified separately.)

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anthony

Founder
Right now, I see several primary problems with the diagnostic structure of PTSD:
  1. There is absolutely zero evidence to support the present structure. It is an agreed opinion from a group of professionals, nothing more, nothing less. There is zero science, thus I see no issue in a group of sufferers taking a go at improving it.
  2. Criterion A defines a level of trauma. Now this has pros and cons. It also has legal and compensation aspects assigned. Remove it, likely lose such things. Keep it, we continue the merry-go-round for level of trauma / trying to define it.
  3. PTSD being separated from complex trauma / possible cPTSD diagnosis. I think it can be done as one, cleverly.
  4. I think the requisite to meet per symptom structure is complete nonsense. Honestly, a requirement to meet one of 5 to 6 symptoms is just stupid when trying to say that PTSD is the severe outcome for catastrophic trauma. If you have endured that level of trauma, you should meet far more than one symptom within any cluster.

Criteron A


There is a single issue to be discussed and resolved first. Do we keep it or get rid of it?

Keeping it, and we continue to define specific types of trauma or a specific level of trauma.

Get rid of it, and we must then tighten and define more specifically the remainder criterion structure, though likely to also lose the aspect of disability that is attached to PTSD uniquely. Most diagnoses do not meet disability standards, PTSD does.

Over time the criterion A has progressively gotten better and worse.

How does it get written, based on all above examples?

My version I'm going to think on and write tomorrow.
 

anthony

Founder
The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone, e. g., serious threat to one's life or physical integrity; serious threat or harm to one's children, spouse, or other close relatives and friends; sudden destruction of one's home or community; or seeing another person who has been or is being, seriously injured or killed as the result of an accident or physical violence.

The person has been exposed to a traumatic event in which both of the following were present:
  • (1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
  • (2) The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
  1. Directly experiencing the traumatic event(s),
  2. Witnessing, in person, the event(s) as it occurred to others,
  3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent and accidental.
  4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

If using criterion A, then I like the exclusionary method, keeping it the same as medicine, being diagnosis by exclusion instead of inclusion.

A. The person was exposed to a traumatic event of such severity that society does not consider such event normal or expected within a lifetime, such exclusions include:
  • relationship dissolution, infidelity, dental work, duress, stress, humiliation, verbal bullying, add to list all the craziness.
Or... inclusion, I would take PTSD back to what its meant to be... a diagnosis for those who have experienced severe trauma, and write as:

A. The person was directly exposed to death, severe injury or sexual violence.

This removes all of the "PTSD from hearing about x" and such events. It limits PTSD to a diagnosis of severe trauma experience, no bracket creep. If you didn't experience severe trauma that relates to death, severe injury or sexual violence.

And well... without criterion A as a pre-qualifier, I guess it will just become a symptom cluster or such.

How would you write Criterion A? Or would you drop it entirely?
 

Changing4Best

MyPTSD Pro
Re: "A. The person was directly exposed to death, severe injury or sexual violence."

I've experienced all 3 of these things. My rapist tried to choke me to death among other things and at a separate time, due to a med that I was given to help me deal with the above, I had a severe anaphalactic [sp?] shock reaction, went into cardiac arrest and had to have CPR done on me. I was also sexually molested as a child and threatened with choking and abused when not compliant at that time too.

As to being labeled, I am on governmental Di$ability with my main reason being for PTSD. I also happen to have Bipolar and Lyme Disease, which just sealed my case, so I got OKed for the Di$ability within a year, which is almost unheard of, especially since I never needed a lawyer.

I have been in therapy for over 10 years, both counselling and drug, and am in a mostly stable condition, however, I certainly do have my "days" when life or my mind throws me a curve ball or two. However, I experience many more "good" days than "bad" ones.

I don't know if this info helps your cause or not, @anthony but I felt the desire to share it.
 
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Sideways

Sponsor
Query hostage situations where non one actually gets hurt, prisoners of war, etc? I think if there is a 'real threat' of death, serious injury or sexual violence that would also qualify.

But to prevent bracket creep, the person's 'perception' that the threat was real should also perhaps be objective, or what a reasonable person in the situation would have thought.

Perhaps situations of 'perceived threat of death, serious injury or sexual violence, where that perception is reasonable inthe circumstances' could be included in Criterion A. State the first proposed sentence as is, then include "or" and add the 'perceived threat' scenarios that qualify.
 

Chava

MyPTSD Pro
Criterion A is very important. We don't even fully understand how to treat Criterion A trauma yet. So lump all relationship issues, and other forms of suffering, and we'd have a big mess in terms of therapeutic response. Also, without criterion A, many of the symptoms overlap with personality disorders, mood disorders, etc. The criterion A trauma fundamentally changes the brain. A bad breakup probably does in some way too, but it's not quite the life threat response that is constantly retriggered. The current criteria make sense...what we need is more and better research around treatment methods. Making the diagnosis loser would only massively complicate this process.
 

anthony

Founder
perceived threat of death, serious injury or sexual violence
Don't you believe that would bracket creep a lot more though?

Now you only need to "perceive" that you may have been seriously injured or sexually violated, and not actually either. Does this not open up to bracket creep again by including such wording?

I guess the whole idea of this is to keep coming up with things, we keep poking holes in as much as we can by having a lot of eyes provide a lot of scenarios, and hopefully we close nearly everything, one way or the other, to derive a suitable solution to the problem.

Saying that... the solution may also to be remove it altogether and allow that broader context be available for PTSD diagnosis.
 

anthony

Founder
what we need is more and better research around treatment methods
I concur with much of what you said Chava... yet I think research probably need be more focused on the 'why' vs the 'how' IMHO.

Why does trauma cause this affect and what is the affect? Versus, How do we treat the problem after the fact? Solving a problem typically entails understanding the problem. This is fundamentally why, in essence, we have no solution to PTSD because we don't understand why it happens.

There is no evidence to support PTSD at present. We have the problem, just no idea what the problem really is or how it occurs.
 

Sideways

Sponsor
Criterion A - having a definition rules out the possibility for people to start making wacky interpretations about 'what is trauma'. You could remove the 'perception' element by using a definition like:

The person was directly exposed to death, severe injury or sexual violence; or
The person was directly exposed to an actual and imminent threat of death, serious injury or sexual violence (to themself?).

As long as you allow room for chronic and serious neglect and emotional abuse during childhood when defining complex ptsd.

With bracket creep, people still have to meet the remaining criteria in order to be diagnosed. Removing the definition of trauma would just make that one bit easier I think...
 
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